Provider First Line Business Practice Location Address:
8327 RESEDA BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-4620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-718-8450
Provider Business Practice Location Address Fax Number:
818-718-8456
Provider Enumeration Date:
12/14/2006